Provider First Line Business Practice Location Address: 
10801 180TH CT NE
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
REDMOND
    Provider Business Practice Location Address State Name: 
WA
    Provider Business Practice Location Address Postal Code: 
98052-7202
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
425-214-6716
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
03/24/2015